Knottnerus Bart J, Bindels Patrick J E, Geerlings Suzanne E, Moll van Charante Eric P, ter Riet Gerben
Department of General Practice, Academic Medical Center - University of Amsterdam, Amsterdam, the Netherlands.
BMC Fam Pract. 2008 Dec 8;9:64. doi: 10.1186/1471-2296-9-64.
Most diagnostic tests for acute uncomplicated urinary tract infections (UTIs) have been previously studied in so-called single-test evaluations. In practice, however, clinicians use more than one test in the diagnostic work-up. Since test results carry overlapping information, results from single-test studies may be confounded. The primary objective of the Amsterdam Cystitis/Urinary Tract Infection Study (ACUTIS) is to determine the (additional) diagnostic value of relevant tests from patient history and laboratory investigations, taking into account their mutual dependencies. Consequently, after suitable validation, an easy to use, multivariable diagnostic rule (clinical index) will be derived.
Women who contact their GP with painful and/or frequent micturition undergo a series of possibly relevant tests, consisting of patient history questions and laboratory investigations. Using urine culture as the reference standard, two multivariable models (diagnostic indices) will be generated: a model which assumes that patients attend the GP surgery and a model based on telephone contact only. Models will be made more robust using the bootstrap. Discrimination will be visualized in high resolution histograms of the posterior UTI probabilities and summarized as 5th, 10th, 25th 50th, 75th, 90th, and 95th centiles of these, Brier score and the area under the receiver operating characteristics curve (ROC) with 95% confidence intervals. Using the regression coefficients of the independent diagnostic indicators, a diagnostic rule will be derived, consisting of an efficient set of tests and their diagnostic values. The course of the presenting complaints is studied using 7-day patient diaries. To learn more about the natural history of UTIs, patients will be offered the opportunity to postpone the use of antibiotics.
We expect that our diagnostic rule will allow efficient diagnosis of UTIs, necessitating the collection of diagnostic indicators with proven added value. GPs may use the rule (preferably after suitable validation) to estimate UTI probabilities for women with different combinations of test results. Finally, in a subcohort, an attempt is made to identify which indicators (including antibiotic treatment) are useful to prognosticate recovery from painful and/or frequent micturition.
大多数针对急性单纯性尿路感染（UTI）的诊断测试此前都是在所谓的单测试评估中进行研究的。然而，在实际临床工作中，医生在诊断过程中会使用不止一项测试。由于测试结果包含重叠信息，单测试研究的结果可能会受到混淆。阿姆斯特丹膀胱炎/尿路感染研究（ACUTIS）的主要目标是确定患者病史和实验室检查中相关测试的（附加）诊断价值，同时考虑它们之间的相互依存关系。因此，在经过适当验证后，将得出一个易于使用的多变量诊断规则（临床指标）。
因排尿疼痛和/或频繁而联系其全科医生（GP）的女性将接受一系列可能相关的测试，包括患者病史询问和实验室检查。以尿培养作为参考标准，将生成两个多变量模型（诊断指标）：一个假设患者前往全科医生诊所就诊的模型，以及一个仅基于电话联系的模型。将使用自助法使模型更稳健。辨别力将在UTI后验概率的高分辨率直方图中可视化，并总结为这些概率的第5、10、25、50、75、90和95百分位数、Brier评分以及受试者操作特征曲线（ROC）下面积及其95%置信区间。利用独立诊断指标的回归系数，将得出一个诊断规则，该规则由一组有效的测试及其诊断价值组成。使用7天患者日记研究当前症状的病程。为了更多地了解UTI的自然病史，将为患者提供推迟使用抗生素的机会。
我们预计我们的诊断规则将有助于高效诊断UTI，这需要收集具有已证实附加价值的诊断指标。全科医生可以使用该规则（最好在经过适当验证后）来估计具有不同测试结果组合的女性的UTI概率。最后，在一个亚队列中，尝试确定哪些指标（包括抗生素治疗）有助于预测从排尿疼痛和/或频繁症状中恢复。
